"Thus it is said that one who knows the enemy and knows himself will not be endangered in a hundred engagements."
Sun Tzu, The Art of War.

Thursday, March 31, 2011

Face of Defense: Doctor Leaves Business for Front Lines

By Army Sgt. Breanne Pye

1st Brigade Combat Team, 4th Infantry Division

KANDAHAR, Afghanistan, March 31, 2011 – Flip through history's pages and you will find countless stories of men and women who have taken incredible journeys and become celebrated heroes.

If you're looking for a modern-day hero, you won't have to look any farther than a 49-year-old combat surgeon here who’s known as “Doc” throughout Task Force Raider.

A former business executive for Burton Snowboards, Army Capt. (Dr.) Douglas Powell is the brigade surgeon for the 4th Infantry Division’s Headquarters and Headquarters Detachment, 1st Brigade Combat Team. His mission here is quite different from that of the design team he’d led with Burton, as he serves on the front lines of Operation Enduring Freedom in Afghanistan.

Powell, a native of Middlebury, Vt., said his journey to becoming an Army surgeon began when he enlisted as a medic in the Vermont National Guard after graduating from college. He competed as part of the Vermont Guard’s winter biathlon team for five years, and was hired by Burton Snowboards as a project manager.

"Doug was an asset to our company," said Jake Burton, the company’s founder. "He was a hard worker who always gave me everything he had, never quit, and always led by example."

Though he thoroughly enjoyed his work at Burton Snowboards and the environment that kind of work provided, Powell said, he continued to feel as if something important was missing from his life.

"After eight years at Burton, I started feeling a strong desire to get away from business and start doing something that would have an impact on people's lives," he said. "At that point, I began volunteering at a hospital in Burlington, Vt."

Within a month of working in the hospital's cancer ward, Powell determined that he needed to have some form of medical service in his career.

When Powell told Burton he was leaving to pursue a career in medicine, Burton said it seemed late to be trying something so ambitious. Even so, he said, Powell’s great intentions and drive, coupled with a little stubbornness, are aspects of his personality that make him the kind of man who is capable of extraordinary things.

"Doug was never a guy to act impulsively," Burton said. "Clearly, his decision was well thought out, so as much as I hated to see him go, I never considered talking him out of his decision."

Powell said after working in a business environment for so long, his volunteer work in the cancer ward was one of the most trying, yet rewarding, experiences of his life. Throughout his time there, he said, he felt the call to practice medicine become stronger and more important in his life.

"While working full-time and volunteering at the hospital, I signed up for night classes to begin knocking out the pre-med classes I needed to complete before applying to medical school," he said.

The process was arduous, he recalled, as his earlier education was in English and history, so he had to take multiple classes to qualify as a medical school applicant.

"I had a lot of ground to make up if I wanted to make it into medical school, so I set a goal for myself," Powell said. "I would take one class, [such as] biology, and if I got an 'A,' I would continue taking classes." He maintained that standard throughout the pre-med program.

After pre-med, Powell said, he knew he had a long way to go before he could practice medicine, so he continued to work for Burton and spent all of his free time volunteering in the cancer ward.

"There were a lot of patients and experiences that began to weave the fabric of the epiphany of my wanting to practice medicine," he said. "But there was one patient in particular who made it all happen."

During his time as a volunteer, Powell explained, he worked with a woman who had terminal breast cancer. Every day, the woman would bring her husband and young daughter to sit with her as she went through chemotherapy.

Powell said the woman never focused on the treatment she knew would not work. Instead, he said, she focused on interacting with her family and giving them memories and joy that would last a lifetime.

"There was something about the woman's drive and passion for life that both inspired and humbled me," Powell said. "She had the most positive attitude as she interacted with her family and doctors in the ward. Even after she died, I never stopped being affected by her enthusiasm."

Though his first application to medical school was denied, he said, the memory of the woman and her family convinced him to continue his efforts to become a medical practitioner.

"Throughout my career, one of the best pieces of advice I ever received was from a medical colleague of mine," Powell said. "That colleague told me, 'Whenever you have doubt about the path you are on, go and spend time with the patients. They will always pull you through. They will always inspire you, and they will always remove doubt.'"

Powell said that advice has proven true in every stage of his medical career, and is as meaningful now as it was in the beginning. He said it wasn't just about spending physical time with the patients, but also reflecting on his experiences with them that gave him inspiration along his journey.

But the denial of his first medical school application did plant some doubt in his mind, Powell said.

"I went out to California to work for a friend of mine in the snowboard industry,” he said, “and really thought I would be continuing in the business."

But on his way back to the East Coast for a final interview for a position in the private sector, he recalled, he ran into a woman in the airport who had a cast on her arm. He stopped to help her with her bags, and in their conversation he learned the woman was on her way to say goodbye to her best friend, who was dying of breast cancer.

On his flight, Powell said, he began reflecting on his own experience with his favorite cancer patient and her family.

"I began writing an essay about my experiences in working with and eventually [having] to say goodbye to that incredible woman," he said. "I wrote her whole story in one take. It was one of those rare times you get the whole story out perfectly, on the very first draft."

Powell said when he re-read the essay as he got off the plane, he knew without a doubt he would apply to medical school again.

"I used that essay as my entrance essay on the medical school application," he said. "After an anxious wait, I was accepted into 10 different medical schools across the country."

Powell chose to attend Wake Forest University School of Medicine in Winston-Salem, N.C. At the time of his post-graduate enrollment, Powell was 40 years old.

Walk through the halls of any American university and you expect to see the bright, young faces of eager students, fresh out of high school, ready to write the first solo chapter in their personal "book of life." But as those young students prepared for their first lecture, they found themselves sitting next to a jovial, white-haired, former business executive they may have mistaken for the professor.

As he started this new stage of his journey, Powell found himself with a much different set of challenges from those his bright-eyed counterparts faced.

"What was tough, very tough, was to be thrown into medical school with young, smart students fresh out of science-based majors," he said. "As a liberal arts major in my undergraduate degree, learning science was something new that I had to undertake to enter medicine."

With only two years of medical classes, taken at night while volunteering and working a full-time, high-level, private-sector job, it was incredibly challenging to become comfortable with the new subject matter he was studying, Powell said.

The challenge for Powell came in trying to keep up with his classmates academically after years of navigating the twists and turns of business. Many of his classmates were fresh out of four-year programs and had a significant amount of lab research experience.

"There were many times during my first and second year when I doubted I was smart or resilient enough to get through the next exam," he said. "I wondered whether I should have chosen another medical school, a less arduous profession, or even if I should have continued my career in business."

But the discrepancy leveled off when his classes transitioned from class work to working with patients.

"It was much easier to apply science to the care of patients than it was to get good grades on standardized exams," Powell said. "But as I got better and better with the former, I continued to struggle with the latter."

It was a battle, Powell said, but he made it through one test and then another, one class and then another, one year and then another, and finally walked across the stage at the end of his four-year program to receive his diploma as a medical doctor. He had finally made it.

"I attribute a lot of my ability to endure those trying times to my background as an aerobic athlete," Powell said. "No matter how busy or overwhelmed I felt, I got out for a run or a long bike ride to recharge my batteries enough to face the next challenge head-on."

The next challenge was medical residency -- practicing medicine under the supervision of a fully licensed physician in a hospital or clinic. Powell chose to complete his residency in internal medicine at MadiganArmyMedicalCenter at Joint Base Lewis-McChord, Wash.

During his residency, Powell competed on the Army 10-miler running team made up of combat arms officers and noncommissioned officers, most who’d served on the front lines in Iraq and Afghanistan.

"Spending time with teammates from my 10-miler team really inspired me to want to practice medicine in a line unit," Powell said. "Hearing their stories and experiences reignited my original passion to engage in public service. I absolutely knew, without a doubt, that I had to serve in a combat arms unit."

Shortly after completing his residency at Madigan, Powell accepted his first assignment as a medical professional as brigade surgeon for the 4th Infantry Division’s 1st Brigade Combat Team “Raiders.”

Army Lt. Col. David Meyer, the brigade’s executive officer, said Powell is an inspiration.

"I can't imagine having the guts and determination to change careers at 40," he said. "I wouldn't even know where to start."

But Powell always knows exactly where to start, Meyer added. Whether it's turning one career in for another or figuring out how to train hundreds of Afghan soldiers and police who can't read to how to administer advanced medical aid on the battlefield, Powell always figures out a way to get the job done, he said.

Figuring out how to overcome seemingly impossible odds is exactly the sort of challenge that inspires Powell to continue his journey as a medical professional in the Army.

"Being a doctor on the front lines gives me an opportunity to effect the care, well-being and medical readiness of a more diverse population of people," he said. "It's an incredibly rewarding, interesting and challenging job." The brigade has established a medical footprint throughout Afghanistan that extends across some of the most dangerous and geographically challenging terrain in the country, he added.

"To be able to deliver health care in an area that didn't previously have an effective health care system in place gives me an incredible feeling of hope and accomplishment," Powell said.

During his deployment, Powell has done a lot more than that. He had helped to design and implement a comprehensive medical training program for the Afghan security forces that will be saving lives long after the last American boots leave Afghan soil.

When he deployed, Powell said, he realized the Afghan forces never would have access to the medical equipment U.S. forces routinely carry with them. He and his team began to put together a training manual that uses common items the Afghan forces would find on the battlefield. Because a large percentage of the Afghan population is illiterate, Powell and his team used step-by-step pictures so Afghan forces would understand it and be able to pass the training on without the help of U.S. forces.

The manual now is a standard for medical training for Afghan forces across Afghanistan.

After all the success Powell has helped bring to 'Raider' Brigade during his time in Afghanistan, It's hard to imagine how he could possibly find a way to challenge himself further as he transitions to the next step of his incredible journey.

In June, Powell begin a fellowship program in critical care medicine at WalterReedArmyMedicalCenter in Washington, D.C.

"This fellowship is an opportunity for me to learn from, and work with, some of the best trauma and burn physicians in the world," he said. "It's also an opportunity for me to teach new resident doctors and medical students critical care medicine."

Meyer said Powell has an exceptional ability to teach. "He easily identifies how people learn, and without passing judgment, is able to create an environment of knowledge for them," he said.

In the meantime, Powell said, he doesn't plan on slowing down his efforts to continue expanding his brigade's medical footprint in Afghanistan any time soon.

"My goal right now is to continue to make sure 'Raider' Brigade is prepared for any medical contingency that might come up," he said. "Experiencing success with the programs we've already implemented here only makes the last few months of this deployment vital to creating even more progress."

Reflecting on the end of his time as a brigade surgeon and the steps it took to get there, Powell said he is just as inspired to continue his work in public service as he was when he first volunteered at the cancer ward in Vermont in 1999.

"Twelve years after I began my journey, I am still discovering, still experiencing rewards that are indescribable," he said. "This calling is as strong and motivating to me now, as it was the day I began my work in the medical field."

But the doctor won't tell you his story is special or unique.

"I think when people consider taking a long journey like I have done, they see the beginning and the end," he said. "They don't realize there is a great amount of life experience collected along the way.

"Each place I traveled throughout this journey has brought great friends and experiences with it," he continued. "When I reached my destination, I looked up and I had less hair and it was all white, but I knew I had done it, without giving up life to get it done."

Still, he added, it's not possible to start an epic journey like this and get to the end without help.

"You make it to the first fork in the road, then up the pass and through the mountains, then down into the valley,” he said. “Ultimately, it's about linking all the little sections together to get to the end."